Fecal Incontinence

What Is Fecal Incontinence?
Fecal incontinence is the inability to control the passing of stool or gas. It can range from occasional leakage to a complete loss of bowel control and can significantly impact quality of life.

Causes
Common causes of fecal incontinence include:

• Diarrhea – Looser stools make control more difficult.
• Muscle or nerve damage – Weak anal sphincter muscles or poor rectal sensation, often associated with aging or childbirth.
• Medical conditions – Diabetes, multiple sclerosis, or spinal injuries.
• Pelvic floor dysfunction – Weakness in the muscles that support the rectum.
• Other conditions – Rectal prolapse or loss of rectal storage capacity.

Symptoms
Signs and risk factors include:

• Inability to hold a bowel movement until reaching the toilet
• Involuntary passing of gas or stool
• Diarrhea
• Rectal prolapse
• Abdominal bloating or discomfort

Diagnosis
It is important to note that gastroenterologists are the first line of treatment for fecal incontinence. Your gastroenterologist may use a combination of exams and tests to determine the cause of chronic constipation such as, digital rectal exam, blood tests, x-ray, colonoscopy, defecography, and anorectal manometry.

Treatment
Treatment typically begins with noninvasive measures such as diet and nutrition, prescription medications, biofeedback and pelvic floor exercises. Often patients are encouraged to start a Bowel Diary which helps to establish regular bowel habits and improve predictability.

Sometimes if these treatments are not adequate, surgery may be recommended.

• Sacral Nerve Stimulator (Interstim TM) – Mild electrical stimulation of sacral nerves improves communication between the brain and bowel/bladder for those who have not responded to conservative therapies. This is typically done under x-ray guidance as an outpatient procedure.
• Surgery – Sphincteroplasty repairs damaged sphincter muscles, especially after injury.

With appropriate evaluation and individualized treatment, many patients achieve significant improvement in bowel control and quality of life.